Provider Demographics
NPI:1891253639
Name:ENVISION MOBILE OPTICAL
Entity Type:Organization
Organization Name:ENVISION MOBILE OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SIBADIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-609-1597
Mailing Address - Street 1:14715 SW 112TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-3326
Mailing Address - Country:US
Mailing Address - Phone:757-609-1597
Mailing Address - Fax:
Practice Address - Street 1:14715 SW 112TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-3326
Practice Address - Country:US
Practice Address - Phone:757-609-1597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty